Provider Demographics
NPI:1952712465
Name:CLAYWELL, INC
Entity Type:Organization
Organization Name:CLAYWELL, INC
Other - Org Name:MEDICA PHARMACY BLOOMFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:502-348-6623
Mailing Address - Street 1:204 CHAPLIN RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40008-7125
Mailing Address - Country:US
Mailing Address - Phone:502-252-8424
Mailing Address - Fax:502-252-7556
Practice Address - Street 1:204 CHAPLIN RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:KY
Practice Address - Zip Code:40008-7125
Practice Address - Country:US
Practice Address - Phone:502-252-8242
Practice Address - Fax:502-252-7556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
KYP076283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145700OtherPK
KY7100285370Medicaid